Treatment of Hypertensive Crisis in Primary Care Health Facilities in Peru, 2019-2024

Hypertensive crises are often managed in primary care, yet guideline-discordant use of short-acting oral antihypertensives remains common in low- and middle-income countries.

We aimed to describe prescribing patterns of captopril, nifedipine, furosemide, and metamizole in Peru.

We conducted a retrospective cohort study using nationwide data from the Peruvian Seguro Integral de Salud (2019-2024). Adults with hypertension and at least one hypertensive crisis episode (systolic blood pressure [BP] ≥ 180 mmHg and/or diastolic BP ≥ 110 mmHg) in primary care were included. Joinpoint regression assessed temporal trends, and multivariable logistic regression identified prescribing determinants.

We analyzed 163,166 episodes from 101,894 patients (mean age 67.3 ± 13.7 years, 60.9% women). Captopril use declined from 40.3 to 34.5% (average monthly percent change [AMPC] - 0.22%; p < 0.001), with steepest decreases in level I-1 healthcare facilities and patients ≥ 80 years. Nifedipine showed no significant overall change (AMPC + 0.07%; p = 0.406) but rose mid-period before declining. Combined captopril or nifedipine use decreased modestly (AMPC - 0.21%; p < 0.001). Furosemide or metamizole were prescribed in 4.7% of episodes, with stable trends but increases in level I-1 healthcare facilities. Higher systolic BP increased the probability of prescribing all medications; diastolic BP showed a non-linear association peaking at 100-110 mmHg. Younger ages were associated with greater medication use.

Short-acting antihypertensives and other agents remain common in Peruvian primary care hypertensive crises. Targeted strategies are needed to align practice with evidence-based recommendations.